Chamberlin Leigh A, Sherman Susan N, Jain Anjali, Powers Scott W, Whitaker Robert C
Division of General and Community Pediatrics, Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
Arch Pediatr Adolesc Med. 2002 Jul;156(7):662-8. doi: 10.1001/archpedi.156.7.662.
Obesity has become a common nutritional concern among low-income, preschool children, a primary target population of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Nutrition counseling efforts in WIC target childhood obesity, but new approaches are needed that address the different perceptions about obesity that are held by clients and health care professionals.
To develop these new approaches, we examined WIC health care professionals' perceptions about the challenges that exist in preventing and managing childhood obesity.
A qualitative study using data transcribed from audiotapes of focus groups and individual interviews. We independently read each transcript and coded themes; then, the common themes were selected through group meetings of the authors.
Kentucky WIC.
Of the 19 health care professionals participating, all had provided nutrition counseling in WIC and all but one were white women.
Twelve major themes clustered into 3 domains. The first domain centered on how WIC health care professionals perceived the life experiences, attitudes, and behaviors of the mothers they counseled. They perceived that mothers (1) were focused on surviving their daily, life stresses; (2) used food to cope with these stresses and as a tool in parenting; (3) had difficulty setting limits with their children around food; (4) lacked knowledge about normal child development and eating behavior; (5) were not committed to sustained behavioral change; and (6) did not believe their overweight children were overweight. The second domain described WIC health care professionals' perceptions of counseling interactions. They felt that (7) they might offend mothers when talking about weight, (8) counseling was driven by protocols, and (9) their nutritional advice often conflicted with the advice from the mothers' relatives, friends, or primary care physicians. The last domain described programmatic suggestions WIC health care professionals offered to address childhood obesity: These included (10) promoting a more client-centered approach to counseling, (11) establishing behavioral change goals that were small and endorsed by the mother, and (12) working with primary care physicians to create a more uniform approach to counseling on obesity.
To become more responsive to the problem of childhood obesity, WIC should consider the following: (1) providing staff training in counseling skills that educate parents on child development and child-rearing and that elicit the client's social context and personal goals, (2) shifting time allocation and programmatic emphasis in the WIC visits away from nutritional risk assessment and toward counseling, and (3) developing collaborations with primary health care providers and community agencies that impact childhood obesity.
肥胖已成为低收入学龄前儿童中常见的营养问题，而这些儿童是妇女、婴儿和儿童特别补充营养计划（WIC）的主要目标人群。WIC的营养咨询工作以儿童肥胖为目标，但需要新的方法来解决服务对象和医护人员对肥胖的不同认知。
为了开发这些新方法，我们研究了WIC医护人员对预防和管理儿童肥胖中存在的挑战的认知。
一项定性研究，使用焦点小组和个人访谈录音转录的数据。我们独立阅读每份转录本并编码主题；然后，通过作者小组会议选出共同主题。
肯塔基州WIC。
19名参与的医护人员中，所有人都在WIC提供过营养咨询，除一人外均为白人女性。
12个主要主题分为3个领域。第一个领域集中在WIC医护人员如何看待他们所咨询的母亲的生活经历、态度和行为。他们认为母亲们：（1）专注于应对日常生活压力；（2）用食物来应对这些压力并作为育儿工具；（3）在给孩子设定饮食限制方面有困难；（4）缺乏关于儿童正常发育和饮食行为的知识；（5）没有致力于持续的行为改变；（6）不认为自己超重的孩子超重。第二个领域描述了WIC医护人员对咨询互动的认知。他们觉得：（7）在谈论体重时可能会冒犯母亲；（8）咨询由方案驱动；（9）他们的营养建议常常与母亲的亲戚、朋友或初级保健医生的建议相冲突。最后一个领域描述了WIC医护人员为解决儿童肥胖问题提出的方案建议：这些建议包括（10）推广更以服务对象为中心的咨询方法；（11）设定小的、得到母亲认可的行为改变目标；（12）与初级保健医生合作，制定更统一的肥胖咨询方法。
为了更积极地应对儿童肥胖问题，WIC应考虑以下几点：（1）提供咨询技能方面的员工培训，使家长了解儿童发育和育儿知识，并了解服务对象的社会背景和个人目标；（2）在WIC访视中调整时间分配和方案重点，从营养风险评估转向咨询；（3）与影响儿童肥胖的初级卫生保健提供者和社区机构开展合作。
